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    Please Read This Carefully: No Special Diet

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    アブドラ フアイルズ
    This document contains a 14-question survey about dietary habits including foods consumed at breakfast, meats, fried foods, fruits and vegetables eaten per week, use of salt, snacks, starches, water and beverage consumption. Respondents are asked to provide demographic information and answer each multiple choice question by selecting the option that best applies to their typical diet. The purpose is to gather information about daily and weekly eating patterns to inform the organization conducting the survey.

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    Please Read This Carefully: No Special Diet

    Uploaded by

    アブドラ フアイルズ
    96 views2 pages
    This document contains a 14-question survey about dietary habits including foods consumed at breakfast, meats, fried foods, fruits and vegetables eaten per week, use of salt, snacks, starches, water and beverage consumption. Respondents are asked to provide demographic information and answer each multiple choice question by selecting the option that best applies to their typical diet. The purpose is to gather information about daily and weekly eating patterns to inform the organization conducting the survey.

    Original Description:

    Questionaire sample

    Original Title

    Example of Questioanaire

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    This document contains a 14-question survey about dietary habits including foods consumed at breakfast, meats, fried foods, fruits and vegetables eaten per week, use of salt, snacks, starches, water and beverage consumption. Respondents are asked to provide demographic information and answer each multiple choice question by selecting the option that best applies to their typical diet. The purpose is to gather information about daily and weekly eating patterns to inform the organization conducting the survey.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    96 views2 pages

    Please Read This Carefully: No Special Diet

    Uploaded by

    アブドラ フアイルズ
    This document contains a 14-question survey about dietary habits including foods consumed at breakfast, meats, fried foods, fruits and vegetables eaten per week, use of salt, snacks, starches, water and beverage consumption. Respondents are asked to provide demographic information and answer each multiple choice question by selecting the option that best applies to their typical diet. The purpose is to gather information about daily and weekly eating patterns to inform the organization conducting the survey.

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    © All Rights Reserved
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    You are on page 1of 2

    Please take a moment to complete this survey to let us

    know your daily and weekly diet. Your response will be


    kept strictly confidential by us. What you have to say is
    very important to us. Your opinion counts. Please respond
    today. Thank you for taking the time to consider our
    questionnaire.
    GENDER

    AGE

    FACULTY

    SEMESTER

    Please read this carefully


    We would like to ask you about some foods which you may eat and yours eating habit. Please
    answer ALL the questions by ticking ( / ) in the box which you think most applies to you.

    1. What kind of special diet do you consume?


    Vitamin

    Supplement

    Regularity
    Per Day

    Milk

    No Special Diet

    Other

    2. During breakfast, what kind of food do you take?


    Cereals

    Porridge

    Oat

    No Breakfast

    Others

    3. About how many pieces of whole meal bread / rolls do you eat on a usual day?
    None

    4. How often on average do you eat a serving of beef, pork or lamb?


    Regularity
    Per Week

    5. How often on average do you eat a serving of any fried food including fried fish or chicken,
    chips, cooked breakfast or samosa?
    Regularity
    Per Week

    6. How often on average do you eat a serving of fruit, including fresh, tinned or frozen?
    Regularity
    Per Week

    7. On a usual day, do you (tick one box)


    Generally add salt to your food without testing it first
    Taste the food, but then generally add salt
    Taste the food , but only occasionally add salt
    Rarely or never add salt
    8. How often on average do you eat sweet or savory snacks such as chocolate, crisps, nuts or
    biscuits?
    Regularity
    Per Week

    9. Excluding chips, how often on average do you eat a serving of potatoes, yams, sweet
    potatoes?
    Regularity
    Per Week

    10. Which type of water did you drink most often in the last 7 days?
    Tap

    Filtered

    Boiled

    Bottled

    11. How much creamy milk, sugar, and honey do you usually have in your drink?
    A Lot

    Some

    A Little

    None

    12. How often on average do you eat a serving of cakes, pies, puddings, pastries or sweets?
    Regularity
    Per Week

    13. How often on average do you eat a serving of pasta, rice, or starch?
    Regularity
    Per Week

    14. How many glasses of water do you drink in a day?


    Regularity
    Per Day

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